Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NEURON SPECIFIC ENOLASE II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990012B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

NEURON SPECIFIC ENOLASE II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990012B
Hospital Revenue Code	306
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.06

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.21
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare Advantage	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.76
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

NEURONTIN,800MG,TAB

Facility

$18.43

Service Code	NDC 68084080211
Hospital Charge Code	60635448
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.76

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$466.81
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,273.62
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$519.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$466.81

NEUROPLASTY,ULNAR NERVE AT ELB

Facility

$16,437.00

Service Code	HCPCS 64718
Hospital Charge Code	16000527
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$2,675.48
Max. Negotiated Rate	$2,675.48
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48

NEUROPLASTY,ULNAR NERVE AT WST

Facility

$17,836.55

Service Code	HCPCS 64719
Hospital Charge Code	16000772
Hospital Revenue Code	360
Min. Negotiated Rate	$506.56
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,637.50
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,675.48
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$563.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$506.56

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$466.81
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,273.62
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$519.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$466.81

NEUROPLST,NERVE OF HND OR FOOT

Facility

$16,437.00

Service Code	HCPCS 64704
Hospital Charge Code	16000771
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$466.81
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,273.62
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$519.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$466.81

NEUROPLSTY MA PEPH NRV A/L,NOS

Facility

$16,437.00

Service Code	HCPCS 64708
Hospital Charge Code	16000490
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$5,656.36
Max. Negotiated Rate	$5,656.36
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36

NEURORRAPHY W/VEIN AUTOGRAFT

Facility

$37,709.10

Service Code	HCPCS 64911
Hospital Charge Code	1600000061
Hospital Revenue Code	360
Min. Negotiated Rate	$1,070.94
Max. Negotiated Rate	$37,820.10
Rate for Payer: Aetna Commercial	$28,358.56
Rate for Payer: Aetna Medicare Advantage	$33,780.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,820.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,820.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,425.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,820.10
Rate for Payer: Cigna Commercial	$20,898.76
Rate for Payer: Cigna Medicare Advantage	$10,425.94
Rate for Payer: Clover Medicare Advantage	$9,904.64
Rate for Payer: EmblemHealth Commercial	$31,277.82
Rate for Payer: Humana Medicare Advantage	$10,738.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,425.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,804.37
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,656.36
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,191.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,425.94
Rate for Payer: Wellcare Medicare Advantage	$10,425.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1,070.94

NEUROSES EXCEPT DEPRESSIVE

Facility

$53,389.81

Service Code	MSDRG 882
Min. Negotiated Rate	$7,161.00
Max. Negotiated Rate	$53,389.81
Rate for Payer: Aetna Commercial	$39,883.33
Rate for Payer: Aetna Medicare Advantage	$53,389.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,042.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,042.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,112.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,042.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,756.00
Rate for Payer: Cigna Commercial	$23,938.22
Rate for Payer: Cigna Medicare Advantage	$17,112.12
Rate for Payer: Clover Medicare Advantage	$16,256.51
Rate for Payer: EmblemHealth Commercial	$51,336.36
Rate for Payer: Humana Medicare Advantage	$17,625.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,112.12
Rate for Payer: Oxford Commercial	$18,920.36
Rate for Payer: UnitedHealthcare Commercial	$25,325.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,112.12
Rate for Payer: Wellcare Medicare Advantage	$17,112.12

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

NEUROSHIELD MEMBRANE 40X30

Facility

$8,000.00

Service Code	HCPCS C9353
Hospital Charge Code	270699482
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.30
Max. Negotiated Rate	$30,375.00
Rate for Payer: Aetna Commercial	$23,085.00
Rate for Payer: Aetna Medicare Advantage	$18,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,491.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,491.25
Rate for Payer: Cigna Commercial	$30,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50
Rate for Payer: UnitedHealthcare Community & State	$1,919.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1,725.30

NEURO STIMULATOR F15

Facility

$60,750.00

Service Code	HCPCS C1778
Hospital Charge Code	270703589
Hospital Revenue Code	278
Min. Negotiated Rate	$9,112.50
Max. Negotiated Rate	$14,701.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,701.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,112.50

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$27,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

NEUROSTIMULATOR FREEDOM 8A

Facility

$112,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270679255
Hospital Revenue Code	278
Min. Negotiated Rate	$3,195.00
Max. Negotiated Rate	$56,250.00
Rate for Payer: Aetna Commercial	$42,750.00
Rate for Payer: Aetna Medicare Advantage	$33,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,687.50
Rate for Payer: Cigna Commercial	$56,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00
Rate for Payer: UnitedHealthcare Community & State	$3,555.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,195.00

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$8,587.50
Max. Negotiated Rate	$13,854.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50

NEUROSTIMULATOR INTERSTEM II

Facility

$57,250.00

Service Code	HCPCS C1767
Hospital Charge Code	270671693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.90
Max. Negotiated Rate	$28,625.00
Rate for Payer: Aetna Commercial	$21,755.00
Rate for Payer: Aetna Medicare Advantage	$17,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,598.75
Rate for Payer: Cigna Commercial	$28,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,854.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,587.50
Rate for Payer: UnitedHealthcare Community & State	$1,809.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1,625.90

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

NEUROSTIMULATOR WIRELESS EXTER

Facility

$6,500.00

Service Code	HCPCS C1787
Hospital Charge Code	270697095
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

Know your out-of-pocket cost for care.

All Charges